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UOTW #69

The patient is a 32 year old male who has a history of IV drug use, presents as a transfer from an outside hospital (OSH) for sepsis. Was taken to the OSH with bouts of lethargy/AMS mixed with episodes of combativeness. Noted to be febrile, hypotensive. Given 5L NS and a dose of vancomycin PTA. On exam you hear a blowing diastolic murmur. What is the diagnosis and most appropriate management for this patient?

Acute endocarditis of the aortic valve
There is severe AR and you can clearly see the vegetation attached to one leaflet of the valve (could be NCC or LCC), difficult to say from this views.
The ventricle is moderately hypokinetic (especially in the first two loops) and dilated, as you would expect in cases of acute AR.
Judging from the dilated IVC (I suppose with minimal respiratory variation ) and numerous B-lines on the lung scan, the patient is overloaded.
I would treat with inotropes (i.e. Dobutamine) plus diuretics.
The need for intubation depends on the level of hypoxia and hemodynamic status